Open heart surgery under total extracorporeal circulation in a patient with advanced glaucoma.

A patient with Wolff-Parkinson-White syndrome and severe glaucoma underwent division of the accessory pathway under total extracorporeal circulation (ECC). During ECC, systolic systemic pressure was maintained at 60-80 mmHg. Arterial pressure in the optic nerve terminal is reported to be half to one-third of systemic arterial pressure and approximates 20 mmHg during ECC. In the case presented, intraocular pressure was maintained below 15 mmHg throughout ECC. Postoperative examination of the patient revealed no change in visual acuity. During ECC, intraocular pressure may exceed the ocular bottom pressure, placing the optic nerve at risk of ischaemia. In cases where optic nerve ischaemia from ECC is likely, preoperative examination by an ophthalmologist is needed.